Provider Demographics
NPI:1194384842
Name:FAVORS, BRIA M (RN-BSN)
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:M
Last Name:FAVORS
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4564 WHITMORE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-8557
Mailing Address - Country:US
Mailing Address - Phone:513-544-5882
Mailing Address - Fax:
Practice Address - Street 1:4564 WHITMORE LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-8557
Practice Address - Country:US
Practice Address - Phone:513-544-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2020-03-18
Deactivation Date:2020-03-05
Deactivation Code:
Reactivation Date:2020-03-18
Provider Licenses
StateLicense IDTaxonomies
OH452986163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty